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Biomedical subjects

I E Haffejee

Publications and source records attributed to I E Haffejee.

At least 19 recordsLinked to original sources
PubMed1991

The status of rotavirus vaccines in 1990.

The status of rotavirus (RV) vaccines in 1990 is reviewed with particular reference to the range of RV strains which infect human beings as well as the antibody response and immunity to naturally acquired RV infections. The requirements for an ideal vaccine are stated and the various approaches towards developing RV vaccines are described. Results of various field trials are given and finally important questions are posed which remain to be addressed if success in producing an ideal vaccine is to be achieved.

Animals↗
PubMed1991

Neonatal group B streptococcal infections in Indian (Asian) babies in South Africa.

In this, the first report of group B streptococcal (GBS) infections in Asian neonates in South Africa, the incidence was 2.65/1000 live births over a period of 3.5 years. Early onset disease (EOD), defined as arising less than or equal to 5 days after birth, was present in 79% cases; in most of these, the onset was before the age of 24 h. One baby presented with two episodes of late onset GBS infection. The incidence of culture-proven neonatal septicaemia during the same period was 12.3/1000 live births, GBS being commonest organism isolated. It was also the most frequent cause of bacterial meningitis in the newborn, accounting for 89% cases. Although neurological signs were present in 40% patients with EOD, only 13.3% had CSF-culture-positive meningitis. Radiographic features of hyaline membrane disease were found in half of the babies with EOD and for whom a chest radiograph was performed, while one had a pneumothorax. The overall mortality was 13.2% which is much lower than that reported in other series.

Female↗
PubMed1990

Typhoid fever in the adult and paediatric Indian population of Durban.

The features of typhoid fever in Indian South Africans are described. In children the illness was usually uncomplicated. However, anaemia, thrombocytopenia and hypo-albuminaemia were found in both adults and children. The initial symptoms on presentation of diarrhoea and vomiting frequently led to a misdiagnosis of gastro-enteritis. The previous administration of antibiotics also resulted in failure to isolate Salmonella typhi in 41% of patients studied. Typhoid acquired in the microbiology laboratory and that seen in visitors returning from India and the Far East is emphasised. The S. typhi isolates were uniformly sensitive to all antibiotics tested. The disproportionately high number of Indians of south Indian ancestry presenting to the R. K. Khan Hospital needs to be investigated.

Adolescent↗
PubMed1990

Circulating and breast-milk anti-rotaviral antibodies and neonatal rotavirus infections: a maternal-neonatal study.

In view of the high prevalence of rotavirus (RV) diarrhoea in Indian (Asian) infants in South Africa, a hospital-based study of 124 mothers and their neonates was carried out to establish the prevalence of maternal and neonatal circulating anti-RV antibodies, RV antibodies in breast-milk, and neonatal RV infections in this population. Thirty-four per cent of the mothers and 38% of the neonates had complement-fixing (CF) serum antibodies. There was a significant correlation between maternal and cord blood antibody levels (p less than 0.001; chi-square test). Fifteen per cent of hospital-born newborns showed asymptomatic RV excretion while still in hospital, mostly at 2-6 days of age, but some even earlier, with two shedding the virus before the age of 24 h. This excretion occurred in both seronegative and seropositive babies. The breast-milk of only 3.2% of the mothers was positive for CF-anti-RV antibodies, implying that either these were not present in the breast-milk or that the CF-test employed was not sufficiently sensitive for detecting these antibodies in milk specimens. Eighteen (18.2%) of 99 infants followed up showed evidence of RV infection 1-7 months after birth; none was symptomatic; 12 excreted RV in the stools while 6 others seroconverted. Asymptomatic reinfection was documented in 4 of 14 babies who had been infected initially as neonates.

Adolescent↗
PubMed1990

Rotavirus studies in Indian (Asian) South African infants with acute gastro-enteritis: I. Microbiological and epidemiological aspects.

This study, which is the first one documenting rotavirus (RV) diarrhoea in Asian infants in South Africa, describes the virological and epidemiological aspects of this disease in this population. Fifty-five per cent of 1142 hospitalized cases investigated over a 31-month period showed a positive stool ELISA for RV. Most of these children stopped shedding RV by days 4-6 of hospital admission, though prolonged excretion was recorded in some acute cases for up to 13 days. Mixed RV-bacterial infections occurred in 7% of the total gastro-enteritis (GE) patients, while 8.6% had pure bacterial gastro-enteritis. Sixteen per cent of 188 GE patients had serum anti-RV complement-fixing (CF) antibodies on admission. Rotavirus diarrhoea occurred in half of the seropositive infants. Seroconversion occurred in only two-thirds of the initially seronegative children who had RV diarrhoea. In 5.6% of the RV diarrhoea patients the infection was acquired nosocomially whilst in the hospital for other illnesses. The age-groups mainly affected were between 3 and 14 months, with a peak at 9-11 months; 3% of the RVGE patients were neonates. Both the RVGE and the total GE admissions showed well-marked winter peaks, with an inverse relationship between RV prevalence and both temperature and humidity. It is concluded that RV is the most important cause of infantile GE in this population, whereas pure bacterial infections play a relatively minor role. Circulating anti-RV antibodies do not necessarily afford protection against RV diarrhoea, probably owing to serotypic differences.

Age Factors↗
PubMed1990

Rotavirus serology and excretion in hospitalized non-diarrhoeal patients.

Despite the well-recognized association between rotavirus (RV) and infantile diarrhoeal disease, a few studies have shown that the isolation rate of RV from the faeces of non-diarrhoeal patients can be high, suggesting that the finding of RV in the stools of individual gastro-enteritis (GE) patients need not necessarily denote an aetiological relationship. A prospective study of rotavirus serology and stool excretion was carried out in a group of non-diarrhoeal paediatric patients. A positive ELISA for RV antigen was found in 13.3% children, which compared favourably with an asymptomatic RV-excretion rate of 16.2% found in normal subjects in the community, but differed significantly from the 54.6% RV-excretion rate found in hospitalized GE patients. This confirms that RV is an important enteropathogen. Furthermore, approximately half of the non-diarrhoeal infants acquired nosocomial RV infections in hospital, most of these being asymptomatic. One-sixth of asymptomatic RV excretors showed evidence of prior exposure to rotavirus.

Antibodies, Viral↗
PubMed1990

Rotavirus studies in Indian (Asian) South African infants with acute gastro-enteritis: II. Clinical aspects and outcome.

In a prospective study of rotavirus (RV) diarrhoea in Indian (Asian) infants in South Africa, it was found that in common with findings elsewhere in the world, vomiting and dehydration are prominent features of this disease. The dehydration was usually isotonic, though both hypo- and hypernatraemia did occur. Hypokalaemia was found to be much less common in RV than in non-RV diarrhoea. Unlike findings elsewhere, no definite 'rotavirus syndrome' associated with pyrexia and respiratory symptoms could be identified in RV diarrhoea as these occurred with equal frequency in non-RV patients. The mean total duration of RV diarrhoea (i.e. before admission plus during the hospital stay) was 5 days. The RV patients took significantly longer to recover from their diarrhoea than the non-RV ones, and mixed RV-bacterial infections prolonged the illness even more. Breast-feeding was associated with milder disease. Less than 2% of both RV and non-RV cases developed persistent diarrhoea of longer than 14 days' duration and this was most frequent in patients under 6 months of age with poor nutritional status.

Child↗
PubMed1990

A double-blind placebo-controlled trial of prednisone in active rheumatic carditis.

In view of the controversy surrounding the use of corticosteroids in the management of active rheumatic carditis, a prospective double-blind controlled clinical trial comparing prednisone (2 mg/kg/24 h in three divided doses) versus placebo was carried out in 35 children with this disease, using strict clinical criteria to define carditis and excluding cases where the diagnosis was doubtful. The duration of the study, which included long-term follow-up, was 7 years. The results failed to show that prednisone at this dosage and frequency was of any benefit either in the short-term clinical response or in the long-term follow-up with regard to later requirement of valvular surgery (using the 5% level of significance). Other findings were that one-third of cases improved with time, irrespective of treatment, most of them having mild to moderate carditis initially.

Adolescent↗
PubMed1990

Cow's milk-based formula, human milk, and soya feeds in acute infantile diarrhea: a therapeutic trial.

Acute infantile diarrhea is often managed by introducing lactose-free diets empirically from the time of diagnosis, in addition to conventional rehydration therapy. In order to assess the efficacy of this, a therapeutic trial was undertaken in which hospitalized gastroenteritis patients previously on milk-formula feeds were randomly fed, from the time of admission, either their original feed or a lactose-free soya preparation; patients previously on human milk with or without a supplement continued to receive this during their diarrheal illness. The results show that in nonrotaviral gastroenteritis, there is no difference in the duration of the illness irrespective of the type of feed given. In rotaviral gastroenteritis, continued breast-feeding significantly reduces the duration of acute diarrhea, while lactose-free soya feeds do not lead to a significant reduction in the duration of the illness when compared to cow's milk-formula feeds. Hence, it is concluded that (a) breast-feeding should be continued during an episode of infantile diarrhea, and that (b) empirical use of soya preparations from the time of hospital admission is not justified; however, the latter should be considered in infants whose purging rate goes up or diarrheal disease severity worsens 3 to 4 days after the onset of diarrhea or hospital stay and who are passing significant amounts of reducing sugars in their stool.

Acute Disease↗
PubMed1990

Persistent diarrhoea following gastroenteritis.

The persistent diarrhoea of greater than 14 days' duration in 17 infants, comprising 1% of 1672 patients who were admitted to a South African Hospital during January 1985-July 1987 for a study on acute gastroenteritis, is described. The age of the patients was between 20 days and 31 months (7.4 +/- 7.8 months), 11 of whom were of less than 6 months and the majority (13) were boys. Fifteen had the nutritional status below the 3rd weight-for-age centile. On admission, gastroenteritis was graded as mild in three patients, moderate in nine and severe in five. Seven, six and four patients had mild, moderate and severe dehydration respectively. Twelve patients required infusion of intravenous (i.v.) fluids for greater than or equal to 14 days to maintain hydration. Complications, such as bronchopneumonia and septicaemia, were present in five and three patients respectively. Nine of the 17 patients shed rotavirus in their stools, 7 of whom continued to do so for 10 to 18 days, and 3 of whom had associated infections either with Salmonella or with enteropathogenic Escherichia coli or both. Any causal agent was not detected in six patients. The mainstay of treatment was oral rehydration therapy with i.v. fluid when necessary and a normal diet of cow's milk-based formula to all except the two breast-fed infants. A failure to improve patients' condition led to the following graded additions to the treatment regimen: lactose-free soya diet, administration of oral gentamicin plus cholestyramine and feeding of semi-elemental formula ("Alfaré," R). The last one gave encouraging results, though the study was not a controlled therapeutic trial.

Acute Disease↗
PubMed1989

Asymptomatic rotavirus infections among normal Indian children in Chatsworth, Durban.

During a 27-month survey in Chatsworth, Durban, serum from 1,041 normal Indian children, ranging in age from birth up to 13 years, was tested for the presence of anti-rotavirus antibodies by means of a complement fixation test. It was found that from an initial high positivity rate of 47.7% in the newborn, there was a sharp drop to 23.8% in the 1-2-month age group (P = 0.0009). This low positivity rate was maintained up to the age of 9-11 months, after which it rose to 46.4% in the 12-17-month age group (P = 0.0006). There was a further significant rise between the 2-3-year and 4-5-year age groups, probably reflecting rotavirus infections in nursery school and/or in the home, the latter being nosocomially acquired from younger siblings. Stool samples were obtained from 829 of the above subjects: overall, 16.2% were positive for rotavirus antigen by enzyme-linked immunosorbent assay; the highest rate (29.5%) of asymptomatic rotavirus infection was in the 12-14-month age group. The data indicate that asymptomatic infection with rotavirus is not uncommon in this community and that older children continue to be exposed to and become infected with rotavirus.

Age Factors↗
PubMed1988

Cefotaxime versus penicillin-chloramphenicol in purulent meningitis: a controlled single-blind clinical trial.

In a prospective, controlled, randomized single-blind clinical trial, treatment with cefotaxime (CTX) was compared with that with standard therapy (ST), which consisted of a penicillin-chloramphenicol combination with or without sulphadiazine, in 31 patients (excluding neonates) with proven bacterial meningitis. The two groups of patients were comparable in age, sex, clinical presentation and causative pathogens. The case fatality rate was 12.5% for the CTX group and 20% for the ST group, but this difference was not significant. The times taken for the cerebrospinal fluid (CSF) to become sterile and the temperature to normalize, the mean duration of treatment, complications and adverse effects were similar for the two regimens. Neurological or developmental abnormalities on follow-up were not significantly different for the two groups. It is concluded that CTX is a suitable alternative for treatment of bacterial meningitis in infants and children.

Cefotaxime↗
PubMed1988

Effect of supine posture on peak expiratory flow rates in asthma.

In order to determine the effect of supine posture alone on the peak expiratory flow rate (PEFR) in children with asthma, 22 children with asthma of varying severity had PEFR readings taken in the standing position and subsequently at 30 minute intervals in the supine position for a period of up to four hours. In order to minimise any stress factors no other procedures--for example, taking of blood specimens--were performed during the duration of the tests, which were carried out in a relatively dust free room with no curtains and minimal furniture. Fifteen non-asthmatic children acted as controls. The results showed a significant drop in the PEFR readings in the supine position in asthmatic children compared with the controls; this reverted back to baseline levels on assuming an upright posture at the end of the test without any medication. It is concluded that airflow obstruction can be induced by supine posture per se in asthmatic children; this may be a major factor contributing to nocturnal wheeze or cough.

Asthma↗